Pancreatic Cancer

Pancreatic cancer is a cancer that begins in the pancreas. The most common type of pancreatic cancer is called adenocarcinoma. There are more rare types of pancreatic cancer but most cases, around 95%, are adenocarcinomas. Adenocarcinomas of the pancreas most often start in the ducts of the pancreas but can also start in the small sacs found at the end of pancreatic ducts called acini. The aicini make multiple types of enzymes that are released into the ducts and are then passed into the small intestine to aid in digestion.

The average person in the United States has a lifetime risk for pancreatic cancer that is 1.5%. Men have a slightly higher risk than women. Ninety percent of the cases are diagnosed after the age of 55. 10% of Pancreatic Cancer is hereditary in nature.

General Risk Factors

Health History

  • Exposure to certain chemicals (pesticides, dyes, and chemicals that may be used in metal refining)
  • Chronic pancreatitis (long-term inflammation of the pancreas)
  • Cirrhosis (condition where scar tissue has replaced damaged liver tissue)
  • Type 2 diabetes
  • Helicobacter pylori (a bacterium that can cause stomach inflammation and ulcers)

Lifestyle

  • A diet high in fatty foods, red meat, pork, and processed meat – some studies have suggested these types of foods increase the risk for pancreatic cancer but others have not
  • Obesity (being very overweight; having too much body fat)
  • Smoking
  • Heavy alcohol intake – Some studies have suggested an increased risk for pancreatic cancer associated with heavy alcohol intake, but this link is still uncertain. Heavy alcohol intake does increase the risk for chronic pancreatitis and cirrhosis, which are risk factors for pancreatic cancer.

Prevention

As with the vast majority of cancers, there is no confirmed way to completely prevent the development of pancreatic cancer. Eating a diet high in fresh fruits and vegetables and exercising in order to maintain a healthy weight are general good health habits.

Symptoms and Screening Methods

Symptoms of pancreatic cancer can include yellowing of the skin and eyes, darkening of the urine, itching, clay-colored stool, upper abdomen or upper back pain, blood clots, a burning feeling in the stomach or other gastrointestinal pains, stomach bloating, floating stools with a bad odor and unusual color, weakness, loss of appetite, nausea and vomiting, chills, fever, and unexplained weight loss. Many of these symptoms can be due to the obstruction of the bile duct, which often occurs as pancreatic cancer develops. Bile (a liquid released by the liver that helps the body digest fats) moves from the liver to the gallbladder and small intestine through the bile duct.

In the United States, there is no standard or routine screening test for pancreatic cancer in the general population. If your doctor considers you to be at a higher risk than the average person for pancreatic cancer due to any of the risk factors mentioned above, including a hereditary cancer syndrome, or if you are experiencing any of the symptoms mentioned above, he or she may recommend that you undergo certain screening tests, which can include an endoscopic ultrasound (EUS) or a MRI/magnetic resonance cholangiopancreatograpy (MRCP). During an EUS a doctor can use an endoscope, a small lighted tube with a camera on the end, to view parts of the gastrointestinal tract including the stomach and beginning of the small intestine in order to take a picture of the pancreas. Biopsies (tissue samples) can be taken during this exam if needed. MRCP is used to view the bile ducts and pancreatic ducts. Biopsies can be taken during this procedure too. Other screening tests can include additional imaging exams and blood tests.

Treatment

If pancreatic cancer is diagnosed following any of the tests above, treatment will depend on the stage of the cancer (how far the cancer has grown or spread). Treatment can include some combination of surgery, chemotherapy and radiation therapy.

References

  1. American Cancer Society: Pancreatic Cancer (http://www.cancer.org/cancer/pancreaticcancer/index)
  2. American Society of Clinical Oncology: Pancreatic Cancer (http://www.cancer.net/cancer-types/pancreatic-cancer)
  3. National Cancer Institute: Pancreatic Cancer treatment (http://www.cancer.gov/cancertopics/pdq/treatment/pancreatic/Patient)
  4. Surveillance, Epidemiology and End Results Program, National Cancer Institute (seer.cancer.gov)
  5. Tersmette AC, Petersen GM, Offerhaus GJ, Falatko FC, Brune KA, Goggins M, Rozenblum E, Wilentz RE, Yeo CJ, Cameron JL, Kern SE, Hruban RH. Increased risk of incident pancreatic cancer among first-degree relatives of patients with familial pancreatic cancer. Clin Cancer Res. 2001 Mar;7(3):738-44. PubMed PMID: 11297271.